Case Management Program Development
NCQA CM-LTSS and Case Mgmt Accreditation

We understand the challenges in implementing a case management program. Our goal is to help health systems, payers, and policymakers develop and enhance person-centered case management strategies, highlight opportunities for alignment and identify areas where more evidence may be needed to understand the cost and quality impact of care. We work with organizations to create and take CM programs to a higher standard by achieving Case Management (CM) and accreditation in NCQA Case Management Long Term Service Support (CM-LTSS).

We understand the challenges in implementing a case management program. From cost to implementation to return on investment, we work with organizations to develop care management business models. Building on our successes and lessons learned we use our experience and knowledge to significantly reduce the amount of time it takes, and risk involved, when transforming care management concepts into sustainable effective population management models of care.

Case Management Program Development

Building successful case management for high-need, high-cost patients is more important than ever as healthcare shifts from a fee-for-service structure to value-based payment programs. Maximizing our body of knowledge gained from our successes and lessons learned we significantly reduce the amount of time it takes, and risk involved, when transforming case management concepts into sustainable effective models of care.

End-to-end services include:

Program development based on evidence-based guidelines and standards of
Tailored interventions to individual patient needs
Staff models job descriptions, and competency assessments
Policy and procedures
Change management
Engagement strategies
Staff training curriculum design and material acquisition/development
Selection and purchase of case management software or creating case management work flow schemas in an existing software
Performance measures and monitoring framework design
Return on Investment strategies
Delegation and risk contracting

NCQA CM-LTSS and CM Accreditation

Achieving NCQA Accreditation gives organizations a competitive advantage in the marketplace, setting higher standards in CM and CM-LTSS program structure, process, and outcomes. Our expert consultants have over 20 years providing direct case management services, developing case management programs in many health care settings such as hospitals, community health centers, physician practices, and health plans. Since 2008 they have used this experience in addition to their NCQA surveyor experiences to work with clients to successfully achieve the highest levels of CM and CM-LTSS accreditation.

Accreditation management services include:

Accreditation standards training.
Strengths-based survey readiness assessment and planning.
Project plan development and project management.
Policy and procedure development and work flow design
Review/design of performance measures and improvement activities.
Coordination and management of project plan activities.
Survey presentation preparation and supporting documentation.
Post-accreditation management of compliance with standards.

Testimonials

Good Afternoon, I wanted to take an opportunity to thank you and Irv for your involvement in CDM’s NCQA UM Survey. We understand that the timeframe between the contract execution and submission date was very limited, but Irv’s professionalism and project management skills made the process painless and a pleasure to work with. After meeting with our Compliance & Audit Manager to review the IRT & documents, she also wanted to extend her praise to Irv on his organizational skills and how we prepped the final documents for the surveyor. These bookmarking and organizational functions are extremely valuable and applicable to how we want to prepare our internal documents for future audits. Thank you again for your assistance on this project. I hope I have the pleasure of working with you all again in future. Any organization that you assist is fortunate to have someone so knowledgeable and are an asset to their team.

Bryan Vargas, Performance Improvement Administrator, Provider Network Solutions, Doral, FL

Baylor Scott & White worked with QFHC on our NCQA Case Management re-accreditation and had a great experience. Quality First is not only knowledgeable, experienced, and organized, but very flexible and responsive to questions. Candi was easy to work with and provided many tools for meeting requirements as well as tracking completion. We interviewed several companies and definitely felt the most comfortable with QFHC. We would highly recommend Quality First for Case Management accreditation needs.

Leanne Clark, MSN, RN, NE-BC, Director, Care Manager Development and Education, Baylor Scott & White Health

I highly recommend having Candi guide you through the LTSS accreditation process. You will grow as an organization and under her leadership you will gain the confidence to continue to achieve success! I have been involved in other accreditation programs but Candi’s compassion in helping her clients learn and grow provided the foundation for a successful CM-LTSS Accreditation with NCQA. Candi brought tremendous value and her knowledge was an asset for our organization to mentor our team in creating policies and procedures to implement new programs. She remained flexible from the onset of our process. Her guidance and support helped us create a program that better meets our client’s needs but also met every accreditation standard with high passing results.

Jerrie O’Rourke, LISW-S, Corporate Director, Senior Care Management, National Church Residences, Columbus, Ohio

Case Management Program DevelopmentNCQA CM-LTSS and Case Mgmt Accreditation